After tabling a vote on the subject at the end of last year, the New Hampshire legislature has passed a bill that will officially expand the state’s Medicaid program. The plan was passed first by the Republican-controlled Senate and then by the Democratic-held House.

The bill, signed into law by Gov. Maggie Hassan on March 26, will take advantage of federal funding earmarked by the Affordable Care Act to expand coverage to adults who earn up to 138 percent of the federal poverty level (approximately $16,000 for a single adult). The federal government offered to pay 100 percent of the cost for the first three years and then gradually drop the level of funding to 90 percent. Since the plan was not enacted by the end of 2013, the state was not able to take advantage of at least six months of this federal funding.

“That number could grow,” says Lisabritt Solsky, assistant director of Medicaid for the state, “because the bill was passed at the end of March and it has not been enacted yet. The legislation calls for a July 1 start date but the bill is not for a ‘vanilla’ expansion. It has a lot of complexities that are not included in the ACA.”

The expansion could provide coverage for an additional 50,000 people, by some estimates. It is unclear at this point how many people will sign on once the plan is rolled out within the next month or two. One problem that opponents have is with the difficulty in ascertaining how much the plan will eventually cost New Hampshire.

“We don’t yet know entirely what the expansion program will mean for New Hampshire,” says House Minority Leader Gene Chandler, (R-Bartlett), who voted against the expansion bill. “We’ll need to see how many people enroll and assess health outcomes before we can say it’s workable and beneficial or not.”

The plan will provide new enrollees a chance to purchase private insurance using federal funding. The state will need a waiver to use this model and the bill would phase nearly 40,000 of the new enrollees out of the program if the state does not get that waiver.

A compromise was agreed that this program will need to be re-visited before the end of the 100 percent funding period in order for it to be re-authorized.

“An important component to the discussion on reauthorization will be how to fund the state’s portion of the costs,” says Chandler. “As federal funding will begin dropping, we’ll need to assess whether or not the state can afford to provide this coverage in perpetuity without seeking additional revenue in the form of new or higher taxes.”

The main thing, Hassan has said, was to take advantage of the current level of funding as soon as possible and then work on details of how it can be continued once administrators see how many people will sign on.

“Our bipartisan health care expansion plan is a historic step forward for the health and financial well-being of Granite State families, businesses and communities,” she said before signing the bill. “It is a fiscally responsible, uniquely New Hampshire solution that will inject $2.5 billion in federal funds into our state’s economy and improve the lives of 50,000 hard-working people who deserve the security of health insurance.”

At this point, New Hampshire joins 26 other states, plus the District of Columbia, in opting to expand Medicaid. Five states remain undecided and the rest have opted not to participate. The only New England state not to participate is Maine.